title: Ventricular fibrillation cardiac arrest due to 5-fluorouracil cardiotoxicity.
abstract: The antimetabolite chemotherapeutic agent 5-fluorouracil is used to treat a variety of cancers. Although 5-fluorouracil is generally well tolerated, its toxicity profile includes potential cardiac ischemia, vasospasm, arrhythmia, and direct myocardial injury. These actual or potential toxicities are thought to resolve upon cessation of the medication; however, information about the long-term cardiovascular effects of therapy is not sufficient. We present the case of a 58-year-old man who had 2 ventricular fibrillation cardiac arrests, with evidence of coronary vasospasm and myocarditis, on his 4th day of continuous infusion with 5-fluorouracil. External defibrillation and cessation of the 5-fluorouracil therapy resolved the patient's electrocardiographic abnormalities. In addition to reporting the clinical manifestations of 5-fluorouracil-associated cardiotoxicity in our patient, we discuss management challenges in patients who develop severe 5-fluorouracil-induced ventricular arrhythmias.
authors.affiliation: Divisions of Cardiology (Drs. Barrett, Fradley, and Francis) and Hematology and Oncology (Dr. Clark), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fradley
authors.forename: Conor D
authors.initials: CD
authors.lastname: Barrett
authors.forename: John R
authors.initials: JR
authors.lastname: Clark
authors.forename: Sanjeev A
authors.initials: SA
authors.lastname: Francis
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced; D047548:Defibrillators; D004334:Drug Administration Schedule; D004554:Electric Countershock / Q000295:instrumentation; D004562:Electrocardiography; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects*; D006323:Heart Arrest / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007263:Infusions, Parenteral; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000139:chemically induced; D014062:Tongue Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents; D005472:Fluorouracil
keywords: Arrhythmias, cardiac/chemically induced; coronary vasospasm/chemically induced; fluorouracil/adverse effects; heart diseases/drug therapy; heart/drug effects; myocarditis/chemically induced; treatment outcome